10 EyeWorld Asia-Pacific | June 2025 CATARACT Some degree of corneal edema following cataract surgery—or any intraocular procedure—is expected. Saba Al-Hashimi, MD, noted that swelling persisting up to 2 weeks postoperatively is typical in the context of cataract surgery. However, when recovery extends to a month or longer, new concerns begin to surface in the surgeon’s mind, prompting a shift in clinical approach: Did I miss Fuchs dystrophy? Is this a Descemet’s separation? Was excessive phacoemulsification energy applied? What should I do next? by Liz Hillman, Editorial Co-Director The Conundrum Of Prolonged Post-Cataract Corneal Edema Preop contributors Several risk factors may predispose patients to prolonged corneal edema following cataract surgery. One example is Fuchs dystrophy—with or without visible guttae. She also noted that a history of herpes simplex virus (HSV) infection could be a contributing factor. “If patients have a known disease, we can counsel them: ‘There is a decrease in the health or number of endothelial cells in your cornea. These are the cells that pump out water from the cornea and help keep it clear. (…) We expect some corneal swelling normally, but you may have more because of this,’” said Himani Goyal, MD. “Without routinely performing specular microscopy preoperatively, low endothelial cell counts—particularly in the absence of guttae—can be easily missed,” added Dr. Al-Hashimi. “However, if the first eye experiences more corneal edema than expected, it may be prudent to perform specular microscopy before proceeding with surgery on the second eye.” Other risk factors, according to Dr. Chan, Dr. Al-Hashimi, and Dr. Goyal, include dense arcus (which may increase the risk of retained nuclear fragments), small pupils (potentially requiring expansion devices and intraocular manipulation), dense cataracts (which often necessitate higher phaco energy), narrow angles, shorter anterior chamber depth (which brings instruments closer to the endothelium during surgery), and advanced age (which may predispose to Descemet’s membrane detachment). Dr. Goyal pointed out that patients with shallow chambers or underlying endothelial disease may be more susceptible to iatrogenic Descemet’s membrane tears. These tears, she said, are common in the area of the main wound. They often flap back up and are of no consequence, but when present, they can contribute to prolonged edema.
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